OAKLEY:
Interstitial cystitis is a terrible problem. It is hard to imagine a more horrible type of pain. The pain is very much nerve-related and involves the bladder. It is also associated, in cases of true interstitial cystitis, with very small bladder volumes and the need to urinate up to 60-100 times a day.

Each time you go to the bathroom it is one of the worst pains you can imagine. In fact, there is a treatment for this which has been used more frequently in the last 7 or 8 years and this is a special application of a spinal cord stimulation. The stimulator electrodes are actually placed over the nerves which go to the bladder.

In a high percentage of cases the pain relief will be rather immediate. It is also associated in true cases of what we call IC with an enlargement of bladder volume and a decrease in the need to urinate to a more normal frequency, and when successful, can be almost like a miracle cure for the pain of interstitial cystitis. So electrical stimulation is definitely something which should be considered for that diagnosis.

This can produce relief of the incision pain for two or three days as the tissue settles down, making it more tolerable to go through various procedures.

MEMBER QUESTION:
Is there a link between heart failure and thoracic back pain?

OAKLEY:
Thoracic back pain is a difficult diagnostic problem, but in certain rare instances it can be related to heart failure and/or vascular problems.

If there is an aneurism of the aorta in the chest, and if the aneurism is getting larger, it can be causing thoracic back pain and be related to heart failure.

MEMBER QUESTION:
What is out on the horizon for lupus sufferers?

OAKLEY:
The pain from lupus has a multitude of potential sources, anything from inflammatory disease to vascular disease and there are a lot of things which can be done with lupus-related pain, depending on the source of the pain.

So, with lupus it's very important to determine what structure is causing the pain and how we should intervene to relieve the pain due to the structure we've identified. The difficulty is there can be many sources of the pain.

Sometimes if the pain is widespread throughout the body using a shotgun approach, such as a drug administration system, can give total-body control of the pain without having to identify a multitude of different sources.

OAKLEY:
There are as many people who believe in this as don't do not believe in this. There is no science. There is an area which is beginning to generate interest in the scientific community in generating magnetic fields which interact with nerves to give pain relief.

So I would not completely rule out the possibility that even the commercially available magnets, such as wristbands, necklaces, pillows and bedliners could have some therapeutic effect, it's just not been demonstrated scientifically.

OAKLEY:
Dental pain or pain due to nerve injury in the area of the teeth is generally an injury to branches of the trigeminal nerve, and there have been successful cases of electrical stimulation applied to the nerve which have helped to relieve the pain due to the nerve injury.

There has also been the use of radio frequency blocks of the peripheral nerves which go to these areas which can help also to take the pain out of the area where the teeth were removed or where the nerve damage has occurred.

These types of things require a good physical examination and understanding of where exactly the pain is occurring before one could apply such techniques as electrical stimulators. These stimulators are very difficult to obtain long-term relief.

OAKLEY:
Pain due to instability in the spine generally can be correlated with the structure on X-ray studies which is seen to be unstable. The pain can often be confirmed as coming from the unstable structure with a block of the nerve using anesthetic.

The pain due to rheumatoid arthritis is inflammatory and can come from joints. But it should also be said that many with rheumatoid arthritis have subluxations due to the disease and one needs to investigate the stability of the spine using X-ray techniques and then use block techniques to determine whether it's just inflammatory pain from the rheumatoid disease or whether they're actually pinching a nerve because of the instability. A good history and good physical examination can also be very helpful.